Changes

==Introduction==

==Introduction==

'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease, metabolic disease and neoplasia'''.

'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==

==Signalment==

'''Symphyseal fractures''' are most common in '''cats''', particularly entire males as they have a tendency to try and escape buildings to find mating females. Fracture of the '''mandibular body''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.  

'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==

==Clinical Signs==

Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site.

Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site. Patients may be presented when the owner notices blood from the mouth.

==Treatment==

==Treatment==

===Symphyseal Fractures===

===Symphyseal Fractures===

Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and placed flush with the skin. The skin incision is closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Body Fractures===

===Mandibular Ramus Fractures===

Fractures of the mandibular body are normally more complex and healing takes approximately''' 9-10 weeks'''. Numerous methods available for fracture stabilisation:

Fractures of the mandibular ramus are normally more complex and healing takes approximately''' 8 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':

'''Conservative treatment''':

   

   

'''Interarcade canine acrylic bonding (ICAB)''':

'''Interarcade canine acrylic bonding (ICAB)''':

This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.  

This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method for caudal mandibular fractures.  

'''Tape muzzle''':

'''Tape muzzle''':

A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.  

A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. A modified technique can be used in cats and brachycephalic dogs but is unlikely to be of use in non-compliant patients.  

'''Interdental wire and acrylic bonding (IWAB)''':

'''Interdental wire and acrylic bonding (IWAB)''':

This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.  

This method is an effective and cheap technique for use in the dog and can be used in cats although is more fiddly. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.  

'''Interfragmentary wiring''':

'''Interfragmentary wiring''':

This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surround teeth and soft tissues.  

This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surrounding teeth and soft tissues.  

'''External skeletal fixator''':

'''External skeletal fixator''':

'''Bone plates''':

'''Bone plates''':

Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

Bone plates cane be used but have limited positions of application to avoid iatrogenic damage to neurovascular bundles and teeth unless miniplates are used.  

'''Hemimandibulectomy''':

'''Hemimandibulectomy''':

This is considered a salvage procedure.  

This is considered a salvage procedure.

===Ramus fractures===

===Fractures of the coronoid process===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.  

These may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.  

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''  

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''  

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.  

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection.

==Prognosis==

==Prognosis==

The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.  

The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.  

{{Learning

{{Learning

{{review}}

{{review}}

[[Category:Oral Diseases - Dog]]

[[Category:Oral Diseases - Dog]]

[[Category:Musculoskeletal Diseases - Dog]]

[[Category:Musculoskeletal Diseases - Dog]]

[[Category:Oral Diseases - Cat]]

[[Category:Oral Diseases - Cat]]

[[Category:Musculoskeletal Diseases - Cat]]

[[Category:Musculoskeletal Diseases - Cat]]